Chromic phosphate‐32 colloid radiosynovectomy for the treatment of haemophilic synovitis: A long‐term follow‐up study

Abstract

Aim We previously reported the outcome of chromic phosphate‐32(32P) colloid synoviorthesis in 53 haemophilic patients with an average follow‐up of 31 months. The purpose of the present study was the long‐term follow‐up of the same cohort on both clinical and radiographic features. Materials Nine patients failed to attend the recall appointment. The mean follow‐up for the remaining 44 patients (52 procedures) was 15 years (range, 14.6‐15.5). The mean age at the time of reassessment was 31 years (range, 18‐43). Results The haemarthrosis frequency was not statistically significant at the latest follow‐up years compared with 31 months (0.8 vs 0.4 per week, P = .3). There was no significant change in the clinical severity of haemophilic arthropathy (P = .5). Most of the treated joints still are in stage III of Fernandez‐Palazzi and Caviglia classification. There was a trend towards the radiologic deterioration of arthritis with nearly 50% of patients at Arnold‐Hilgartner Stage V. 13% of patients underwent a total knee arthroplasty (TKA). The age at which the initial radiosynovectomy was performed was significantly higher in patients who had a TKA than those who had not (22 vs 15 years, P < .002). Conclusion The bleeding control effect of 32P on the target joint remains over time; however, it did not appear to halt the progression of radiographic changes in haemophiliacs. It could delay the need for TKA if it performs at the right time.

Radiosynovectomy in haemophilic synovitis and arthropathy of the knee: A scoping review

“…11,33,34 Similar findings have been observed with P-32 in PWH followed over 15 years. 13 One study reports contradictory findings with significant worsening in knees after a minimum of 5 years in patients receiving Y-90 RSV; however, we argue against the validity of the statistical analysis used as the Petersson score is treated as continuous data using ANOVA, when really it represents semi-quantitative ordinal data. 16 Synovial thickness is an imaging proxy used to measure synovitis.…”

“…5,12,13,18,20,36 Complete resolution is also observed in a quarter of cases within the 6 months following treatment though there is a trend towards losing this status over time and at 15 years there is no significant difference in haemarthrosis frequency observed. 5,12,13 Limited data is available for rhenium isotopes on bleeding, with reduction in the average number of bleeds and complete bleeding resolution in the short term in most patients reported. 7,27 However, this also appears to deteriorate in the medium and long term.…”

“…5 Statistically significant decrease in pain scores was observed however at 15 years in the same cohort with an excess of 60% reduction in pain score at 15 years. 13 The reason for this is unclear, but potentially the result of attrition bias (17% of patients in this small study failed to re-attend and were excluded from the analysis).…”

“…5,18 Long-term follow up of patients receiving P-32 suggests that there is a significant functional deterioration in RSV patients after 15 years likely due to the natural history of the underlying arthropathy. 13 Following Y-90 RSV, most patients maintained or improved knee flexion (88%) and extension (84%). 29 The magnitude of ROM improvement appears small; < 5% improvement in flexion/extension following initial RSV or < 10-degrees in 'most joints' in the short term have been reported.…”

“…28,30,43 Additionally, no cancer cases were identified following P-32 RSV with a maximum follow up of 17 years in a small number of patients. 13,36 A large study using Canadian registry data of cancer rates following RSV in multiple joints (69% knees), found no significant increase in the hazards ratio of any type of cancer compared to the general population for either Y-90 or P-32. 9 Whilst adjustment for underlying disease did not alter this conclusion, the numbers of patients within this mixed sample with haemophilia was too small to assess the disease-specific risk.…”